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AFFIDAVIT RELATING TO SECTION 13.12 (c) OF A GENERAL ORDINANCE
OF THE CITY OF OSHKOSH RELATING TO THE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
) SS
WINNEBAGO COUNTY )
•
r ; 7 c_�� 1 I L i Pepti-et
(Name) 0 (Address)
first being duly sworn on oath, deposes and says that he is not
a licensed electrician in the City of Oshkosh and that he has
1 applied for an electrical permit to do electrical work, in a
residence and /or auxiliary buildings (intended solely for pur-
poses associated with a residence) which is owned and occupied
by him, or Is being constructed in his name, as his personal •
home and that said residence or auxiliary buildings being so
wired are not to be used or erected for rental purposes or for
resale to present or prospective purchasers.
Affiant understands that the electrical work authorized by
•the permit applied for in connection with this affidavit, must
be done only by this affiant and that he cannot employ others to
assist with the electrical work but members of his immediate
family.
Dated this day of 7(12 1
. plc sd
•
Subscribed and sworn t. before
this iC 4 d day of , 1.i•. �J , 19.1Y
�►
i ll,
•
Notary Public, Winnebago o nt.y, Wisconsin
My Commission
Expires: — J UNE 7 1987
PERMIT NO. 1 5Y •P . DATE 7 R
or
ELEC. CONTR.
OWNER i"411017111-! ' ";,� , . GUL
ADDRESS / 2 / A
NATURE OF WORK •,-,Pl `- ..-4-..--jr-,--z--e__ ELEC. SERV. NEW i'i �CHANGED TEMP.
DESC. TYP �--- 3 G 3- tc. VOLTS /-2-i 40 AMPS) Dn
FIX' S >- c' A- °< RECEP'D' S X CIRC' S v)'
APPLIANCES y
--- .. ?' A. sI ■
SIGNS . / tL `t'
INSP. ROUGH SERVJC 11/ �5
. FINALP - 5 -
EST. COST S D' ° ° VJ PERMIT F _ a; — DATE PD.2 - 7 $'/
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